Understanding Lipoedema: Why are the Legs Most Affected?

KEY TAKEAWAYS

• Lipoedema is a complex, chronic fat and connective tissue disorder of the lower body (and occasionally the arms) affecting women and driven by hormonal changes.

• In most women, the lower body has significantly more fat cells, and these have significantly more oestrogen receptors than fat in the upper body does. This is why lipoedema primarily affects the legs. 

• Be Sculptured offers liposuction using the “lymph-sparing” tumescent local anaesthetic technique for Stage 1 and Stage 2 lipoedema in Sydney and on the Gold Coast. These tumescent liposculpture procedures are performed by an experienced, highly-trained proceduralist using local anaesthesia. Sedation is provided by anaesthetists / sedationists for extra patient comfort. 

Understanding Lipoedema

A complex, long-term condition experienced almost exclusively by women, lipoedema is a genetic/hereditary disorder of fat and loose connective tissue. It results in a disproportionate increase in adipose (fatty) tissue, which changes the overall body shape. It mostly affects the legs, although the arms can also be impacted in some women. The torso is unaffected.

It is classified by:

TYPE

• Type I: Abnormal fat affecting the buttocks and the hips
• Type II: Abnormal fat affecting the lower limb from buttocks and hips to thighs, above the knee
• Type III: Abnormal fat affecting the lower limb from buttocks to ankles
• Type IV: Abnormal fat affecting the upper limbs
• Type V: Abnormal fat  affecting the lower limbs from knees to ankls only; rare

STAGE

• Stage 1: Mild symptoms. Disproportional fat accumulation in the hips, buttocks, and thighs. Skin appears smooth and normal, but tiny nodules (like pebbles) can be felt. Mild pain and bruising may occur.

• Stage 2: Fat distribution is more pronounced. Skin surface appears uneven with a dimpling, spongy, or “cottage cheese” appearance. Pain and tenderness increase.

• Stage 3: Significant buildup of fatty tissue. Legs (occasionally arms as well) can look like rectangular, inflated balloons, with large folds of fat and skin. Upper and lower body imbalance is much more obvious. Overhanging skin/ fat folds, especially around the knees and thighs. Mibility may be affected. 

• Stage 4: Severe Stage 3 symptoms with associated lymphoedema. Chronic pain, mobility issues caused by gross anatomical changes with inflamed, fibrotic tissue. 

Frequently confused with and misdiagnosed as obesity or lymphoedema, lipoedema is almost always symmetrical (both sides of the body are affected equally). The hands and feet are not impacted; this can cause a “bracelet” effect at the ankles and wrists. The skin often looks dimpled or “floppy”, fat under the skin can feel hard and nodular, and it’s common to experience pain and tenderness in the affected areas. The condition can have major implications for a woman’s self-confidence.

It’s estimated that 1 in 11 women in Australia is affected by lipoedema – but, due to frequent misdiagnosis and/or women “just living with it” without seeking medical attention, the actual number may be significantly higher. 

Why Does Lipoedema Primarily Affect The Lower Half of the Body?

Lipoedema is hormonally driven and tends to run in families; if your mother or grandmother had it, it’s more likely you and/or your daughters will as well. It usually begins with weight gain associated with puberty, hormonal contraceptive use, pregnancy, and menopause. 

Hormones also explain why lipoedema’s effects are primarily seen in the hips, buttocks, and legs. 

The female hormone oestrogen plays a major role in the storage and utilisation of fat for energy. This hormone is the reason why female bodies primarily store subcutaneous (under the skin) fat in the hips and thighs; this is biologically necessary for energy for reproduction. 

(When a woman’s oestrogen levels drop at menopause, normal fat distribution shifts to the abdomen and visceral (surrounding internal organs) fat accumulates; this is why so many women’s body shapes change dramatically in middle age.)

Fat cells in the lower body also contain significantly more (by up to threefold) estrogen receptors than those in the torso. When a person has lipoedema, and these fat cells are triggered by hormonal changes, they expand and grow in a way that is unregulated; the lower body also grows and expands disproportionately.

Do I Have Lipoedema – or Just “Fat” Legs?

Signs you may have lipoedema as opposed to “just having fat legs” include:

• The body appears unbalanced – you have fatty buildup in your buttocks, thighs, calves, but your upper body is a smaller size than your lower body. 

• Dieting and exercising have little to no impact on your legs.

• The legs look and feel lumpy, dimpled, or nodular, like there’s something under the skin. These tissues may harden.

• You experience fatigue, pain, tenderness, heaviness, swelling, and/or inflammation in the legs.

• Your legs bruise easily. 

• You may have varicose veins.

• Normal daily activities (including walking) may become more difficult.

Lipoedema Treatment and Management

Unlike normal fat, lipoedema does not respond to diet and exercise. While overall weight loss (especially if you are very overweight or obese) can certainly reduce the symptom load, the abnormal fatty deposits and characteristic appearance remain in the affected areas regardless of losing weight. 

While there is no cure, there are several ways to manage and treat the symptoms of lipoedema:

• Participate in regular, gentle exercise to improve mobility and help reduce swelling. This includes swimming, walking, riding a bicycle, or water aerobics.

• Adopt an anti-inflammatory, heart-healthy diet.

• Drink plenty of water every day to remain adequately hydrated and flush toxins from your tissues.

• Moisturise your skin on your legs (and arms if affected).

• Use compression stockings – ask your GP or pharmacist about this.

• See your GP for an accurate diagnosis. Get a second opinion if you feel you need to. Medical treatments may include medications or supplements to help reduce swelling and inflammation.

• If you are overweight, losing weight can help relieve the burden on your joints, improve mobility, and enhance your overall quality of life.

• Lymphatic drainage massage may help.

• Lipoedema liposuction can help remove abnormal fat deposits and improve pain, mobility. Surgical management for Stage 1 and Stage 2 lipoedema , and considered one of the most lymph-sparing methods, is tumescent liposculpture, 

Can GLP-1s Like Ozempic Help with Lipoedema?

Lipoedema does worsen with weight gain, and a lot of people with more severe lipoedema do have a body mass index (BMI) of 35 or higher. Furthermore, the burden on the lower body when one is overweight can contribute to the pain and mobility issues associated with lipoedema. Losing excess weight can only be a positive for women with lipoedema.

GLP-1 medicines can be very effective for significant weight loss in people who are medically suited to and approved for using them. Initially developed to treat Type II diabetes, they are also being shown to potentially offer other medical benefits in terms of cardiovascular outcomes, brain health, and may even reduce cancer risk; the effect these medications have on inflammation in the body likely drives these results. They do not, however, target or treat lipoedema fat. 

Managaing lipoedema with lipoedema liposuction appears to improve the response to GLP-1s for people who use these medicines and also have lipoedema. It’s crucial to see your GP. Only use these medicines if they are prescribed for you by a qualified Australian healthcare provider, are approved by the TGA (Australia’s regulatory body responsible for ensuring the safety, quality and effectiveness of therapeutic goods, including all medications). Learn more here.

Contact Be Sculptured for a Consultation 

Undiagnosed, unmanaged lipoedema places an unnecessarily high physical and emotional burden on women with this condition. 

If you have been diagnosed with Stage 1 or Stage 2 lipoedema, or believe you may have this condition, Be Sculptured can help.

Be Sculptured is a leading liposculpture clinic with locations in Sydney and on the Gold Coast. We offer liposculpture management for the legs; these are suitable for people with a BMI of under 35 and Stage 1 or Stage 2 lipoedema. 

Our highly trained and exceptionally experienced proceduralist, Dr Meaghan Heckenberg, is caring, compassionate, and has herself undergone liposculpture, which gives her a unique insight into her patients and their clinical experience. She has performed these procedures on almost two thousand patients

Fill in our consultation form or email [email protected]. You may, alternatively, book a consultation via our website or call 0484 898 977 during business hours.